A New Method to Quantify Demand on the Upper Extremity During Manual Wheelchair Propulsion

Objective To use an ergonomics-based rating that characterizes both demand on, and capacity of, upper-extremity muscle groups during wheelchair propulsion to help identify the muscle groups most at risk for pain or overuse injury in a relatively demanding wheelchair propulsion task. Design Case series. Setting Biomechanics research laboratory. Participants Sixteen manual wheelchair users with complete (American Spinal Injury Association grade A) T6-L2 paraplegia. Interventions Not applicable. Main outcome measures Internal peak joint moments required by each of the major upper-extremity muscle groups for propelling a wheelchair up a ramp; isometric strength of each of the muscle groups in positions simulating wheelchair propulsion; and wheelchair propulsion strength rating (WPSR) for each muscle group, calculated by normalizing the joint demands to their capacity. Results The largest joint moment was for shoulder flexion, at 39.7±13.9Nm. Shoulder flexion also accounted for the peak WPSR value of 66.5%±20.3%. Supination and pronation movements had low peak moment requirements (3.4Nm, 5.0Nm, respectively) but high WPSR values (41%, 53%, respectively). Conclusions Even a relatively benign ramp (2.9°) places a large demand on the musculature of the upper extremity, as assessed by using the WPSR to indicate muscular demand